Hip Fracture Flashcards
Q: What is the approx. incidence of hip fractures per year?
329,000`
Q: What percent of hip fractures occur in women?
76
Q: 1 in ____ individuals die within 1 year of a hip fracture.
5
Q: 1 in _____ require nursing home care for at least 1 year.
4
Q: What percent of hip fractures result from falls?
90
Q: The risk of fracture ____________ every 5 years after the age of 50.
doubles
Q: The fracture rate of institutionalized individuals is _____x greater than those in the community.
5-11
Q: ________% of survivors fail to recover to prior functional status within 1 year of injury.
26-75
Q: Presence of a comorbidity increases mortality by ~____%.
16
Content: Intracapsular Hip Fracture (2)
- Involve femoral head or neck
- Higher rate of non-union and AVN
Content: 3 types of intracapsular fractures
- Subcapital 2. Transcervical 3. Basicervical
Content: Extracapsular Hip Fracture (2)
- Involve trochanteric region
- Types trochanteric, intertrochanteric, subtrochanteric
Content: 4 Stages of the Garden Staging System
1 = incomplete, may be impacted
2 = complete, non-displaced
3 = complete, partially displaced
4 = complete, fully displaced
Q: Which stages of the Garden Staging System require surgery?
2-4, however, by the time we see them all the stages will look the same to us
Q: What are the steps in fracture management and which step involves PTs?
Steps: reduction, fixation, restoration of function PT = restoration of function
Content: 4 goals of fracture management
- Pain control
- Reduction and fixation in good position
- Return to function
- Prevent complications
Content: 3 indications for a conservative treatment plan for fracture management
- Unstable medical status
- Non-displaced fractures
- Risk of surgery vs. risk of immobility
Content: 3 Surgical treatments for hip fracture
- ORIF
- HA
- THA
Q: What 4 factors should be considered when hip surgery is an option?
- Age
- Mobility status
- Mental state
- Pre-existing bone and joint pathology
Q: ORIF or pinning is thought as _______ ___________.
bone conserving
Q: What is the failure rate of ORIF?
20-36%
Q: What population is ORIF suggested for?
Younger, highly active pts
Q: ORIF is the treatment of choice for _______________ fracture.
Extracapsular
Q: Hemiarthroplasty is considered for ______________ fracture.
Intracapsular
T/F: ORIF appears to have better outcomes than HA.
False, flip it
Q: What is the failure rate of HA?
6-18%
Q: What is the risk of dislocation with HA?
~5%
Q: With HA you see a deterioration of function after ______ years
3-5
T/F: With HA only the femoral component is replaced.
True
Term: Femoral head articulates with acetabulum, but is fixed to the stem
Unipolar
Term: Femoral head articulates with both acetabulum and stem
Bipolar
T/F: Bipolar replacements are better than unipolar replacements.
False, no evidence that one is better than the other
T/F: It is unclear whether cemented or uncemented is the superior approach.
True
Q: THA is considered for _______________ fracture
intracapsular
T/F: THA has better outcomes than HA beyond 3 years.
True
Q: What is the risk of dislocation for a THA?
5-10%
T/F: THA is never used to revise a failed ORIF or HA.
False, often
Content: Posterior THA precautions (3)
- No ADD past neutral
- No flexion past 90
- No IR
Content: Anterior THA precautions (3)
- No ABD
- No (excessive) extension
- No ER
Q: What are the 3 risks associated with posterior THAs?
- Dislocation
- Infection
- DVT
Q: What are the 3 risks associated with anterior THAs?
- Increased operative time
- Increased blood loss
- Infection
Content: Complications of hip surgery (8)
- CV
- Pneumonia
- Pressure ulcers
- Delirium
- UTI
- Wound infection
- Depression
- Malnutrition
Q: What is the single best predictor of operative mortality following hip fracture?
Delirium
Q: Acute delirium occurs in _________% of post-op pts.
30-50
Q: Delirium is usually observed within POD _____, resolved by POD ___.
1-5, 7
Content: DVT (3)
- Very common complication of hip fracture
- Incidence of up to 60% w/o prophylaxis
- Incidence of 20-30% w/prophylaxis
Content: PE (3)
- Incidence ~10-15%
- Mortality ~2-10%
- Account for 14% of deaths due to hip fracture
Q: What is the key to rehab for hip fractures?
Early mobilization
Q: Delayed mobilizaiton is associated with… (5)
- Delirium
- Pneumonia
- Increased length of stay
- Greater 6 mo. mortality
- Poorer 2 mo functional performance
T/F: The vast majority (90%) of hip fractures occur due to trauma.
False: falls
T/F: Falls are the leading cause of death in individuals greater than 65 years old.
True
Diagram: Risk factors for falls
